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目的比较Whipple手术与腹腔镜技术在胰腺癌治疗中的优缺点,初步评价腹腔镜技术治疗胰腺癌的临床效果。方法收集并分析2010年1月至2014年1月22例行胰腺癌手术治疗的患者,并对其进行全程随访。其中Whipple手术组14例,腹腔镜组8例,观察比较两组患者手术时间、失血量、住院时间、切缘阳性率、术后并发症发生率等。结果腹腔镜组手术时间、术中出血量、术后住院时间均明显低于Whipple手术组,差异均有统计学意义(P均<0.05);疼痛评估:术后24 h内,两组VAS评分差异无统计学意义(P>0.05),但术后48、72 h,腹腔镜组VAS评分明显低于Whipple手术组,差异均有统计学意义(P均<0.05)。腹腔镜组术后并发症发生率(12.5%)明显低于Whipple手术组(42.9%),差异有统计学意义(P<0.05)。术后病理组织学检查两组切缘阳性率均为0。两组均无手术死亡病例。结论腹腔镜在治疗胰腺癌,尤其是胰体、尾部肿瘤时,比Whipple手术具有优势。
Objective To compare the advantages and disadvantages of Whipple operation and laparoscopy in the treatment of pancreatic cancer and to evaluate the clinical effect of laparoscopy in the treatment of pancreatic cancer. Methods Twenty-two patients undergoing surgical treatment of pancreatic cancer between January 2010 and January 2014 were collected and analyzed. All patients were followed up. Whipple surgery group of 14 cases, laparoscopic group of 8 cases, observation and comparison of the two groups of patients operating time, blood loss, length of stay, positive margins, the incidence of postoperative complications. Results The operation time, intraoperative blood loss and postoperative hospital stay in the laparoscopic group were significantly lower than those in the Whipple group (all P <0.05). Pain assessment: Within 24 hours after operation, the VAS score There was no significant difference between the two groups (P> 0.05). However, the VAS scores of laparoscopic group at 48 and 72 h after operation were significantly lower than those of Whipple group (all P <0.05). The incidence of postoperative complications in laparoscopic group (12.5%) was significantly lower than that in Whipple surgery group (42.9%) (P <0.05). Postoperative histopathological examination of the two groups of positive margins were 0. There were no surgical deaths in both groups. Conclusions Laparoscopy has advantages over Whipple’s surgery in the treatment of pancreatic cancer, especially pancreatic body tumors and tail tumors.